Brain Tumours

Question 1

What is the most common type of brain tumour in adults?

Answer 1

Metastatic brain tumour

Question 2

What are the most common locations from which tumours metastasise to the brain?

Answer 2

Lung (most common)
Breast
Bowel
Skin (namely melanoma)
Kidney

Question 3

What is the most common primary brain tumour in adults?

Answer 3

Glioblastoma multiforme

Question 4

What is the prognosis of glioblastoma multiforme?

Answer 4

Poor prognosis appox. 1 year

Question 5

How does a glioblastoma multiforme appear on imaging?

Answer 5

Solid tumour with central necrosis and a rim that enhances with contrast.
Associated with vasogenic oedema.

Question 6

What is the the histology of glioblastoma multiforme?

Answer 6

Pleomorphic tumour cells border necrotic areas

Question 7

What is the treatment of glioblastoma multiforme?

Answer 7

Surgical excision with postoperative chemotherapy and/or radiotherapy.
Dexamethosone is used to treat oedema.

Question 8

What is the second most common brain tumour in adults?

Answer 8

Meningioma

Question 9

What is the pathophysiology of meningioma?

Answer 9

Benign, extrinsic tumours of the CNS. Arise from the dura mater of the meninges and cause symptoms by compression rather than invasion.

Question 10

What is the histology of meningioma?

Answer 10

Spindle cells in concentric whorls and calcified psammoma bodies.

Question 11

What is the investigation of a meningioma?

Answer 11

CT (contrast enhancement) and MRI

Question 12

What is the treatment of meningioma?

Answer 12

Observation
Radiotherapy
Surgical resection

Question 13

What is the pathophysiology of vestibular schwannoma?

Answer 13

(Acoustic neuroma)
Benign tumour arising from the 8th cranial nerve (vestibulocochlear nerve)
Presents with hearing loss, facial nerve palsy and tinnitus.

Question 14

What disease is associated with bilateral vestibular schwannoma?

Answer 14

Neurofibromatosis type 2

Question 15

What is the histology of vestibular schwannoma?

Answer 15

Antoni A or B patterns

Verocay bodies

Question 16

What is the treatment of vestibular schwannoma?

Answer 16

Observation
Radiotherapy
Surgery

Question 17

What is the epidemiology of pilocytic astrocytoma?

Answer 17

Most common primary brain tumour in children

Question 18

What is the histology of pilocytic astrocytoma?

Answer 18

Rosenthal fibres (corkscrew eosinophilic bundle)

Question 19

What is the pathophysiology of medulloblastoma?

Answer 19

Aggressive paediatric brain tumour, arises within the infratnetorial compartment Spreads through the CFS system.
Treatment is surgical resection and chemotherapy.

Question 20

What is the histology of medulloblastoma?

Answer 20

Small, blue cells.

Rosette pattern of cells.

Question 21

What is the pathophysiology of ependymoma?

Answer 21

Commonly seen in 4th ventricle, may cause hydrocephalus.

Question 22

What is the pathophysiology of oligodendroma?

Answer 22

Benign, slow-growing tumour common in the frontal lobes.

Question 23

What is the histology of oligodendrome?

Answer 23

Calcifications with ‘fried-egg’ appearance.

Question 24

What is the pathophysiology of haemangioblastoma?

Answer 24

Vascular tumour of the cerebellum, associated with von Hippel-Lindau syndrome

Question 25

What is the histology of haemangioblastoma?

Answer 25

Foam cells and high vascularity

Question 26

What is the pathophysiology of pituitary adenoma?

Answer 26

Benign tumours of the pituitary gland. Either secretory (producing hormone excess) or non-secretory.

Question 27

What hormones/diseases can be produced in access by a pituitary adenoma?

Answer 27

Prolactin - Prolactinoma ACTH - Cushing's disease GH - Acromegaly THS - Hyperthyroidism (Can also lead to depletion)

Question 28

What visual defect can be caused by a pituitary adenoma?

Answer 28

Bitemporal hemianopia - compression of the optic chiasm.

Question 29

What are the investigations of pituitary adenoma?

Answer 29

Pituitary blood profile and MRI

Question 30

What is the treatment of a pituitary adenoma?

Answer 30

Hormonal or surgical (Transphenoidal resection)

Question 31

What is the pathophysiology of a craniopharyngioma?

Answer 31

Paediatric tumour | Solid/cystic tumour from remnants or Rathke's pouch.

Question 32

How does a craniopharyngioma present?

Answer 32

Hydrocephalus Bitemporal hemianopia Hormonal disturbance

Question 33

What is the investigation of a craniopharyngioma?

Answer 33

Pituitary blood profile and MRI

Question 34

What is the treatment of craniopharyngioma?

Answer 34

Surgery with or without postoperative radiotherapy

Question 35

What are the three most common tumours in adults and what is the proportion of each?

Answer 35

60% - Glioma (primary) and metastatic disease 20% - Meningioma 10% - Pituitary lesions

Question 36

What are the most common tumours in children?

Answer 36

Astrocytomas | Medulloblastomas

Question 37

Tumours in which location can grow the largest without causing symptoms?

Answer 37

Frontal and Temporal lobe

Question 38

How are CNS tumours diagnosed?

Answer 38

MRI scanning

Question 39

Why might tumours still be resected if not curable?

Answer 39

Debulking can prevent raised ICP, increasing survival and QoL

Question 40

What tumours are typically easy to resect entirely?

Answer 40

Meningiomas

Question 41

What tumours have a propensity to attacking normal tissue?

Answer 41

Gliomas